Article Detail - JA DME

Noridian wants clarification on the requirements for insulin-treated beneficiaries to be eligible for Continuous Glucose Monitors (CGM). According to coverage criterion 4A found in the Glucose Monitors LCD L33822, a beneficiary must receive insulin treatment to be eligible for CGM. It is a common misperception among providers and suppliers that medications such as Mounjaro, Ozempic, and Metformin (not all-inclusive list) are insulin and can be used to qualify patients for (CGM). These medications are not a form of insulin, and the beneficiary receiving them would not be considered insulin treated based on these medications.

Note: Non-insulin beneficiaries could still qualify for a CGM under coverage criteria 4B.

Additional information on CGM coverage criteria can be found in the Glucose Monitors Local Coverage Determination (LCD) L33822 and related Policy Article.